The common site for a femoral hernia to emerge is in the loose areolar tissue of the femoral ring at the medial end of the femoral canal. There is a tendency for the hernia to pass inferiorly within the femoral sheath with the femoral vein and artery to the fossa ovalis. As it descends, it may take with it either extraperitoneal fat or the anterolateral wall of the bladder.
Emerging at the fossa ovalis, the hernia is forced to protrude superiorly by the fusion of the femoral sheath with the deep fascia of the thigh. This tendency may result in a large femoral hernia being mistaken clinically for an inguinal hernia.
Compression of the femoral vein or long saphenous vein by the hernia within the sheath can lead to the subtle clinical sign of unilateral superficial venous dilatation.
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